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1、学案心肺复苏术 vv病人呼吸心跳停止时采取的一切抢救措施称心肺复苏病人呼吸心跳停止时采取的一切抢救措施称心肺复苏病人呼吸心跳停止时采取的一切抢救措施称心肺复苏病人呼吸心跳停止时采取的一切抢救措施称心肺复苏 Rescue approach and treatment for the patients suffering respiratory Rescue approach and treatment for the patients suffering respiratory or cardiac arrest.or cardiac arrest.vv复苏目的复苏目的复苏目的复苏目的: : :
2、 :恢复呼吸、循环及病人的神志恢复呼吸、循环及病人的神志恢复呼吸、循环及病人的神志恢复呼吸、循环及病人的神志 Aim : recovery of breath, circulation, consciousnessAim : recovery of breath, circulation, consciousnessvv内容包括内容包括内容包括内容包括: : : :评估判断，人工呼吸，电击除颤，胸外心脏按压评估判断，人工呼吸，电击除颤，胸外心脏按压评估判断，人工呼吸，电击除颤，胸外心脏按压评估判断，人工呼吸，电击除颤，胸外心脏按压, , , , Contents: assessments, a
3、rtificial, ventilation, defibrillation, chest Contents: assessments, artificial, ventilation, defibrillation, chest compression, life supportcompression, life support一系列的评估和干预的过程一系列的评估和干预的过程一系列的评估和干预的过程一系列的评估和干预的过程(a series of assessments and interventions)(a series of assessments and interventions)
4、概念概念 conceptiong 评估与判断(assess and gauge)(assess and gauge)意识意识意识意识: : : :反应、瞳孔反应、瞳孔反应、瞳孔反应、瞳孔 Consciousness: response, pupilConsciousness: response, pupil呼吸呼吸呼吸呼吸: : : : 胸廓及腹部运动、呼吸形式胸廓及腹部运动、呼吸形式胸廓及腹部运动、呼吸形式胸廓及腹部运动、呼吸形式( ( ( (濒死样呼吸濒死样呼吸濒死样呼吸濒死样呼吸) ) ) ) Respiration: movement of chest and abdomen, typ
5、e of respiratory Respiration: movement of chest and abdomen, type of respiratory movement, (agonal respirations)movement, (agonal respirations)心脏搏动：心音、心脏搏动：心音、心脏搏动：心音、心脏搏动：心音、 脉搏、心电图脉搏、心电图脉搏、心电图脉搏、心电图 Heart beat : cardiac sound , pulse , ECGHeart beat : cardiac sound , pulse , ECG 心跳骤停有三种情形心跳骤停有三种情形
6、心跳骤停有三种情形心跳骤停有三种情形sudden cardiac arrest (SCA)sudden cardiac arrest (SCA) vv心室颤动心室颤动心室颤动心室颤动 ( ( ( (ventricular fibrillation)ventricular fibrillation)vv心室停顿心室停顿心室停顿心室停顿( ( ( (ventricular standstill)ventricular standstill)vv心电机械分离心电机械分离心电机械分离心电机械分离 ( (electromechanical dissociation)electromechanical d
7、issociation)2000200020002000指南基本生命支持顺序指南基本生命支持顺序指南基本生命支持顺序指南基本生命支持顺序The sequence of BLS in 2000 AHA GuidelineThe sequence of BLS in 2000 AHA GuidelineThe sequence of BLS in 2000 AHA GuidelineThe sequence of BLS in 2000 AHA Guideline基本生命支持基本生命支持基本生命支持基本生命支持Basic Life Support Basic Life Support (BLS)(
8、BLS)评估评估assessmentassessment呼救呼救EMS activationEMS activation包括包括ABCABC和除颤和除颤D D心肺复苏术心肺复苏术ABCs of CPR, and the D of ABCs of CPR, and the D of DefibrillationDefibrillationA A气道通畅气道通畅 airwayairwayB B人工呼吸人工呼吸 BreathBreathC C人工循环人工循环 CirculationCirculationD D除颤除颤 DefibrillationDefibrillationl为了培训和记忆l for
9、 training and remembering 气道通畅技术气道通畅技术Techniques for the establishment of airwayTechniques for the establishment of airway舌与会厌阻塞气道 The tongue and epiglottis obstruct the pharynx仰头举颏法Head Tilt-Chin Lift Maneuver气道通畅技术气道通畅技术Techniques for the establishment of airwayTechniques for the establishment of
10、airway推举下颌法Jaw-Thrust Maneuver气道通畅技术气道通畅技术Techniques for the establishment of airwayTechniques for the establishment of airway异物梗阻气道Foreign bodies cause airway obstruction FBAO横膈下腹部冲击手法Subdiaphragmatic abdominal thrustHeimlich maneuver气道通畅技术气道通畅技术Techniques for the establishment of airwayTechniques
11、for the establishment of airway 口咽通气道Oropharyngeal airways鼻咽通气道Nasopharyngeal airways气道通畅技术气道通畅技术Techniques for the establishment of airwayTechniques for the establishment of airway食管气管导管食管气管导管 Esophageal-Tracheal CombitubeEsophageal-Tracheal Combitube喉罩气道喉罩气道 Laryngeal Mask AirwayLaryngeal Mask Air
12、way气管内导管气管内导管 Endotracheal IntubationEndotracheal Intubation人工呼吸人工呼吸 Provide Rescue BreathingProvide Rescue Breathing口对口人工呼吸 Mouth-to-mouth rescue breathing口对鼻人工呼吸Mouth-to-nose rescue breathing人工呼吸 Provide Rescue Breathing球囊面罩通气装置 bag-mask ventilation device人工呼吸 Provide Rescue Breathing球囊面罩通气 bag-ma
13、sk ventilation 人工呼吸人工呼吸 Provide Rescue BreathingProvide Rescue Breathing人工气道通气 ventilation with an advanced airway食管气管导管食管气管导管 Esophageal-Tracheal CombitubeEsophageal-Tracheal Combitube喉罩气道喉罩气道 Laryngeal Mask AirwayLaryngeal Mask Airway气管内导管气管内导管 Endotracheal IntubationEndotracheal Intubation接呼吸机或呼吸
14、囊Connect with ventilator or bag人工呼吸 Provide Rescue Breathing先进行两次人工呼吸先进行两次人工呼吸, ,每次人每次人工 呼 吸 时 间 超 过工 呼 吸 时 间 超 过1 1秒秒 。潮气量潮气量500-600ml500-600ml，有胸廓起，有胸廓起伏伏, ,避免迅速而强力的人工呼避免迅速而强力的人工呼吸。吸。 有人工气道二人进行有人工气道二人进行CPRCPR，则，则没分钟通气没分钟通气8 8至至1010次次, ,人工呼吸人工呼吸时时 , ,胸 外 按 压 不 应 停 止 。胸 外 按 压 不 应 停 止 。 没有人工气道没有人工气道,
15、 ,救助者复苏的救助者复苏的每周期为每周期为3030次按压和次按压和2 2次呼吸次呼吸, ,在按压暂停进行人工呼吸在按压暂停进行人工呼吸, ,每每次 呼 吸 超 过次 呼 吸 超 过1 1 秒。秒。 Give 2 rescue breaths, each over 1 Give 2 rescue breaths, each over 1 seco- nd.seco- nd.with tidal volume of 500 to600 mL to with tidal volume of 500 to600 mL to produce visible chest rise, avoid rapi
16、d produce visible chest rise, avoid rapid or forceful breaths. or forceful breaths. When an advanced airway is in place When an advanced airway is in place during 2-person CPR, ventilate at a during 2-person CPR, ventilate at a rate of 8 to 10 bpm, no pause in chest rate of 8 to 10 bpm, no pause in
17、chest compressions for delivery of compressions for delivery of ventilations.ventilations. without an advanced airway in without an advanced airway in place, the rescuer(s) should deliver place, the rescuer(s) should deliver cycles of 30 compressions and 2 cycles of 30 compressions and 2 breaths. Th
18、e rescuer delivers the breaths. The rescuer delivers the breaths during pauses in breaths during pauses in compressions and delivers each compressions and delivers each breath over 1 second.breath over 1 second.循环Circulation胸外心脏按压胸外心脏按压胸外心脏按压胸外心脏按压( ( ( (external chest compression)external chest com
19、pression)除颤除颤除颤除颤(defibrillation)(defibrillation)药物治疗药物治疗药物治疗药物治疗(drug):(drug): 肾上腺素肾上腺素肾上腺素肾上腺素( (Epinephrine)Epinephrine) 多巴胺多巴胺多巴胺多巴胺 ( (Dopamine)Dopamine) 抗心律失常药抗心律失常药抗心律失常药抗心律失常药(antiarrhythmic)(antiarrhythmic)胸外心脏按压胸外心脏按压胸外心脏按压胸外心脏按压( ( ( (external chest compression)external chest compression)
20、ECC心泵机制心泵机制心泵机制心泵机制( ( ( (cardiac pump)cardiac pump)胸胸胸胸 泵泵泵泵 机机机机 制制制制 ( ( ( (thoracic thoracic pump)pump)Pump the blood to the organs 按压部位按压部位(position of compression)胸骨下半部,双乳头之间The lower half of the sternum between nipples胸外心脏按压胸外心脏按压胸外心脏按压胸外心脏按压( ( ( (external chest compression)external chest co
21、mpression)ECC techniques一只手的掌跟在胸骨一只手的掌跟在胸骨下半部，另一只手放下半部，另一只手放于其上，双手平行。于其上，双手平行。掌跟的长轴放在胸骨掌跟的长轴放在胸骨的长轴上。手指伸展的长轴上。手指伸展或交锁，但应离开胸或交锁，但应离开胸部。部。Place the heel of one hand on the lower half of the sternm and the other hand on top of the first ,so that the hands are parallel. Be sure the long axis of the heel
22、 of your hand is placed on the long axis of the sternm your hand may be either extended or interlaced but should be kept off the chest.胸外心脏按压胸外心脏按压胸外心脏按压胸外心脏按压( ( ( (external chest compression)external chest compression)ECC techniques双肘关节固定，双臂双肘关节固定，双臂垂直。垂直。双肩在双手正上方以双肩在双手正上方以使每次胸部挤压的冲使每次胸部挤压的冲击直接使胸骨
23、下压。击直接使胸骨下压。每次挤压后必须完全每次挤压后必须完全解除压力，使胸部回解除压力，使胸部回到正常位置。到正常位置。使手与胸骨接触以保使手与胸骨接触以保持正确手的位置。持正确手的位置。Lock the elbows in position, with the arms straightened. Position your shoulders directly over your hands so that the thrust for each chest compression is straight down on the sternum. Release the pressure
24、completely and allow the chest to return to its normal position after each compression.Keep your hands in contact with the victims sternum to maintain proper hand position.胸外心脏按压胸外心脏按压胸外心脏按压胸外心脏按压( ( ( (external chest compression)external chest compression)ECC techniques 按压频率按压频率按压频率按压频率100100100100
25、次次次次/ / / /分钟分钟分钟分钟 按压幅度按压幅度按压幅度按压幅度4-5cm4-5cm4-5cm4-5cm 按压按压按压按压- - - -通气比值通气比值通气比值通气比值30:230:230:230:2 按压与放松时间按压与放松时间按压与放松时间按压与放松时间1:11:11:11:1 每每每每2 2 2 2分钟更换按压者分钟更换按压者分钟更换按压者分钟更换按压者 尽量不间断尽量不间断尽量不间断尽量不间断, , , ,间断不超过间断不超过间断不超过间断不超过10101010秒秒秒秒 Compression rate 100/minCompression rate 100/min Depre
26、ss the sternum 4 to 5cmDepress the sternum 4 to 5cm Compression-ventilation ratio 30:2Compression-ventilation ratio 30:2 Compression /relaxation time 1:1Compression /relaxation time 1:1 Switch the compressor every 2 min.Switch the compressor every 2 min. Minimize interruption of chest Minimize inter
27、ruption of chest compression, limit interruption to no compression, limit interruption to no more than 10 seconds.more than 10 seconds.除颤(fibrillation treatment)defibrillation SCA SCA SCA SCA 最常见和最初发生的心律最常见和最初发生的心律最常见和最初发生的心律最常见和最初发生的心律失常是心室纤颤（失常是心室纤颤（失常是心室纤颤（失常是心室纤颤（VFVFVFVF）。）。）。）。 电除颤是终止电除颤是终止电除颤
28、是终止电除颤是终止 VF VF VF VF 最有效的方最有效的方最有效的方最有效的方法。法。法。法。 随着时间的推移，成功除颤的随着时间的推移，成功除颤的随着时间的推移，成功除颤的随着时间的推移，成功除颤的机会迅速下降。机会迅速下降。机会迅速下降。机会迅速下降。 短时间短时间短时间短时间 VF VF VF VF 既可恶化并导致心既可恶化并导致心既可恶化并导致心既可恶化并导致心脏停搏。脏停搏。脏停搏。脏停搏。 the most frequent initial rhythm in the most frequent initial rhythm in witnessed SCA is ventr
29、icular witnessed SCA is ventricular fibrillation (VF)fibrillation (VF) the treatment for VF is electrical the treatment for VF is electrical defibrillation, defibrillation, the probability of successful the probability of successful defibrillation diminishes rapidly defibrillation diminishes rapidly
30、 over time, over time, VF tends to deteriorate to VF tends to deteriorate to asystole within a few minutes. asystole within a few minutes. 电除颤与人工除颤仪电除颤与人工除颤仪electrical defibrillation and defibrillatorelectrical defibrillation and defibrillator手动除颤手动除颤手动除颤手动除颤manual defibrillationmanual defibrillatio
31、n右侧电极板放在病人右锁骨下方，左电极板放在与左乳头齐平的左胸下外侧部 The right (sternal) chest pad is placed on the victims right infraclavicular chest ,the apical (left) pad is placed on the victims inferior-lateral left chest, lateral to the left breast.电极放置电极放置 Electrode Placement 电除颤的能量选择电除颤的能量选择 Shock Energies 单向波形除颤仪: 360JMon
32、ophasic Waveform DefibrillatorsMonophasic Waveform Defibrillators双向波形除颤仪:150J-200JBiphasic Waveform DefibrillatorsBiphasic Waveform Defibrillators 除颤步骤除颤步骤steps to operate defibrillatorsteps to operate defibrillator打开电源粘贴电极板选择能量离开病人按电击按钮Power onAttach electrode padsSelect energyClear the victim and
33、press the shock button除颤+心肺复苏术 Defibrillation Plus CPR关键性联合关键性联合A Critical CombinationA Critical Combination 早期除颤对于救活心脏骤停（早期除颤对于救活心脏骤停（早期除颤对于救活心脏骤停（早期除颤对于救活心脏骤停（SCASCA）病人至关重要）病人至关重要）病人至关重要）病人至关重要Early defibrillation is critical to survival from SCAEarly defibrillation is critical to survival from SC
34、A 存活链概念存活链概念( ( ( (Chain of Survival)Chain of Survival)生存链(Chain of Survival) 早期识别和启动急救医疗早期识别和启动急救医疗早期识别和启动急救医疗早期识别和启动急救医疗系统（系统（系统（系统（EMSEMSEMSEMS）或联系当地急）或联系当地急）或联系当地急）或联系当地急救反应系统救反应系统救反应系统救反应系统120120120120 早期由旁观者进行早期由旁观者进行早期由旁观者进行早期由旁观者进行CPRCPRCPRCPR 早期进行电击除颤早期进行电击除颤早期进行电击除颤早期进行电击除颤 早期由医务工作者进行复早期由医
35、务工作者进行复早期由医务工作者进行复早期由医务工作者进行复苏后的高级生命支持苏后的高级生命支持苏后的高级生命支持苏后的高级生命支持 Early recognition of the emergency Early recognition of the emergency and activation of the emergency and activation of the emergency medical services (EMS) or local medical services (EMS) or local emergency response system: emergency
36、 response system: “phone 120”“phone 120” Early bystander CPR Early bystander CPR Early delivery of a shock with a Early delivery of a shock with a defibrillatordefibrillator Early advanced life support Early advanced life support followed by postresuscitation care followed by postresuscitation care
37、delivered by healthcare providersdelivered by healthcare providers. .越快越好 the sooner the better BLS法则(algorithm)BLS algorithm小结：小结：CPRCPR操作流程操作流程判断意识：判断意识：判断意识：判断意识：拍打肩部并呼叫病人拍打肩部并呼叫病人求救呼叫：求救呼叫：求救呼叫：求救呼叫：急呼急呼120120，或者通知身旁其他人呼叫救护人员，或者通知身旁其他人呼叫救护人员开放气道：仰头抬颏法开放气道：仰头抬颏法开放气道：仰头抬颏法开放气道：仰头抬颏法，左手小鱼际按压额部，右手食指
38、中指抬举颏部，使头颈后，左手小鱼际按压额部，右手食指中指抬举颏部，使头颈后仰仰去除异物：去除异物：去除异物：去除异物：用单手食指钩出口腔中固体异物（未见异物，可省去此操作）用单手食指钩出口腔中固体异物（未见异物，可省去此操作）检查呼吸：面感检查呼吸：面感检查呼吸：面感检查呼吸：面感鼻孔气流、鼻孔气流、耳听耳听耳听耳听呼吸声音、呼吸声音、眼观眼观眼观眼观胸廓起伏（专业人员需同时检查脉胸廓起伏（专业人员需同时检查脉搏，时间小于搏，时间小于1010秒）秒）人工通气：人工通气：人工通气：人工通气：吸一口气，一手食指拇指捏住鼻孔，口对口密闭，两次缓慢人工通气吸一口气，一手食指拇指捏住鼻孔，口对口密闭，两
39、次缓慢人工通气（每次吹气时间不少于（每次吹气时间不少于1 1秒，两次吹气间留有呼气时间，吹气同时要观察到胸廓起伏）秒，两次吹气间留有呼气时间，吹气同时要观察到胸廓起伏）胸外按压：部位胸外按压：部位胸外按压：部位胸外按压：部位取胸骨中下三分之一处，也可简便取两乳头连线中点（右手沿一侧取胸骨中下三分之一处，也可简便取两乳头连线中点（右手沿一侧肋弓向上摸到剑突，左手掌根紧贴剑突上两横指处，两手掌根重叠，手指翘起不得按肋弓向上摸到剑突，左手掌根紧贴剑突上两横指处，两手掌根重叠，手指翘起不得按于肋骨上）；于肋骨上）；频率频率频率频率100100次次/ /分，按下与松开的时间相同（松开时手掌不得离开胸壁）
40、；分，按下与松开的时间相同（松开时手掌不得离开胸壁）；两手臂肘关节伸直，垂直用力，两手臂肘关节伸直，垂直用力，幅度幅度幅度幅度4 4到到5 5厘米；按压通气比为厘米；按压通气比为3030比比比比2 2再次检查：再次检查：再次检查：再次检查：完成完成5 5个循环的按压通气后评估心跳呼吸（面感鼻孔气流、耳听呼吸声音、个循环的按压通气后评估心跳呼吸（面感鼻孔气流、耳听呼吸声音、眼观胸廓起伏，同时手指触摸颈动脉搏动）眼观胸廓起伏，同时手指触摸颈动脉搏动）即刻除颤：即刻除颤：即刻除颤：即刻除颤：涂抹电极膏，取涂抹电极膏，取360J360J功率，充电后招呼周围人远离病人身体，功率，充电后招呼周围人远离病人
41、身体，非同步非同步非同步非同步电电击一次（击一次（部位部位部位部位：胸骨右缘第二肋间、左腋前线第五肋间）：胸骨右缘第二肋间、左腋前线第五肋间）继续抢救：继续抢救：继续抢救：继续抢救：继续继续5 5个循环的按压通气，然后再次检查心跳呼吸（若心跳呼吸无恢复可个循环的按压通气，然后再次检查心跳呼吸（若心跳呼吸无恢复可重复重复“ “除颤按压通气检查除颤按压通气检查除颤按压通气检查除颤按压通气检查” ”步骤；若心跳呼吸已恢复，摆放复苏体位）步骤；若心跳呼吸已恢复，摆放复苏体位）Sequence of CPRStep 1Step 2Step 3Step 4One rescuer CPRCompressio
42、n rate 100/minCompression rate 100/minDepress the sternum 4 to 5cmDepress the sternum 4 to 5cmCompression-ventilation ratio 30:2Compression-ventilation ratio 30:2Compression /relaxation time 1:1Compression /relaxation time 1:1Switch the compressor every 2 min.Switch the compressor every 2 min.Minimi
43、ze interruption of chest Minimize interruption of chest compression, limit interruption to no compression, limit interruption to no more than 10 seconds.more than 10 seconds.Two rescuer CPRGive 2 rescue breaths, each over 1 Give 2 rescue breaths, each over 1 seco- nd.seco- nd.with tidal volume of 50
44、0 to600 mL to with tidal volume of 500 to600 mL to produce visible chest rise, avoid rapid produce visible chest rise, avoid rapid or forceful breaths. or forceful breaths. When an advanced airway is in place When an advanced airway is in place during 2-person CPR, ventilate at a during 2-person CPR
45、, ventilate at a rate of 8 to 10 bpm, no pause in chest rate of 8 to 10 bpm, no pause in chest compressions for delivery of compressions for delivery of ventilations.ventilations. without an advanced airway in without an advanced airway in place, the rescuer(s) should deliver place, the rescuer(s) s
46、hould deliver cycles of 30 compressions and 2 cycles of 30 compressions and 2 breaths. The rescuer delivers the breaths. The rescuer delivers the breaths during pauses in breaths during pauses in compressions and delivers each compressions and delivers each breath over 1 second.breath over 1 second.Master the important technique
